N545 – Sympathectomy - unilateral - lumbar
OHIP Otolaryngology Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
Unilateral lumbar sympathectomy is a surgical procedure involving the interruption of the sympathetic nerve pathway in the lumbar region. The fee for this procedure includes all common and specific elements of a surgical service, such as pre-operative evaluation, the surgical procedure itself, and post-operative care as defined in the Schedule of Benefits (see , , , ).
When to Use
- Use N545 for a unilateral lumbar sympathectomy performed for vascular insufficiency or chronic neuropathic pain conditions.
- Select N545 when the procedure is limited to one side; for bilateral procedures, you must bill N545 with the appropriate bilateral modifier or secondary code as per Schedule of Benefits guidelines.
Common Pitfalls
- Billing N545 with a second surgical assistant without prior authorization from a medical consultant, which will result in an automatic rejection.
- Failing to document the Injury Severity Score (ISS) in the medical record when claiming the E420 trauma premium, leading to audit recovery.
Billing Tips
- Ensure the procedure start time is clearly documented to support the application of after-hours premiums E409 or E410 if the surgery is non-elective and falls within those time windows.
Effective: April 1, 2025
Z. Spinal Surgical Procedures
SPINAL SURGICAL PROCEDURES
Surgical
Spinal Surgical Procedures
When claiming the trauma premium E420, the medical record must list the patient's Injury Severity Score (ISS).
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